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I sat quietly surveying my field of vision like a pilot of a battle tank. And I realized that I was looking at a killing field. It mostly happened last night, but it was veiled in the darkness. I had no idea that it was this vicious, until I saw it in the morning light.

In front of my eyes lay several casualties. Perhaps in the hundreds. They were all dead. Crushed and mangled. Their innards scattered on the battle field.

Life is short. I know for them it is shorter. And it just become even shorter. Life can be unfair sometimes.

All they want is freedom. Freedom to live. Freedom to propagate. Freedom to roam on a beautiful warm summer’s night.

But I want my freedom too. And my freedom to roam clashed with theirs.

I don’t like it. Nor did I plan it. It was not my intention to annihilate them. No, not at all! They were just in the wrong place, and in the wrong time. Or was it me that was in the wrong place and in the wrong time?

Few weeks ago, my family visited a 90-acre field of wild flowers. It was actually a farm land before, but the owners turned it into a natural prairie. Here in Iowa, the state gives incentives through federal conservation program wherein the government will give yearly rental payment in exchange of farmers turning their agricultural land into a prairie or a wooded area. This is one way of reclaiming industrial lands into natural habitats for the wild life.

Wanting to see more beautiful field of flowers, my wife checked on a website and learned that there is a lavender farm here in Iowa. She envisioned that it will be an expansive gorgeous fields of lavender flowers. Besides, the farm is located near a scenic route, the Loess Hills, which is included in the National Scenic Byways of America, meaning it is a must-see drive. Since we have not seen it yet, so we drove to it last weekend.

The lavender field is about two hours drive away from our place. Here in the United States’ midwest, two hours drive is nothing. At least when we say two hours drive, we mean we’re really driving mostly at maximum speed limit. Unlike in other parts of the world, like in Manila, two hours drive means a distance you can get to in twenty minutes but you’re stuck in traffic for two hours.

After finishing our Sunday morning chores, we packed the family in the car and drove. My college-age daughter, who is home for the summer, was not even feeling well that morning due to menstrual cramps, but we drag her anyway so she won’t miss it. She just brought a pillow and laid down in the backseat.

It was a relatively cool day for a summer, as it was cloudy and even had intermittent showers. In fact we encountered some heavy rains along the way, which to me, just made the trip more interesting.

As we approached our destination, we passed by an overlook area. It has a tower where you can view the surrounding scenery. My daughter was feeling better already at that time, that she got off the car and also climbed the tower.

When we came to a nearby town just minutes to our destination, we decided to stop for lunch first before heading to the place. We discovered a nice old diner. It has a 1960’s theme, or perhaps they just did not change it since they opened. We found out that this diner was a major hub even back in the days, as it was near a major train station.

When we continued on our trip, we got lost as our GPS directed us not to the exact site. Yes, I gave the verdict that the GPS was at fault, and it cannot defend itself. We phoned the farm’s number and it re-directed us to its location.

Finally we found the place. As we were pulling into their parking lot, we saw the field in front of us and it was nothing like what we imagined or expected. It was a dud. A let-down. A disappointment.

No stretches of beautiful lavender. No expansive field of wonderful flowers. Instead, it was a patch of drying bushes. In its defense, perhaps we were just expecting too much.

As we already drove for two hours, so we still went down and checked the farm, including the small shop they have in that place. We did not tarry though.

We then decided to drive further in a road that has a sign “National Scenic Byway.” It was said that this scenic byway, the Loess Hills, has a unique terrain, formed by windblown silt, called loess. No other place in the world except the one in China, where there are higher loess hills formation than this place in Iowa.

After driving for some time in this said scenic byway, we admit that they were interesting, but we’re not utterly impressed. Maybe because we have already driven from US coast to coast, and we have seen more stunning scenic byways. We turned around and headed for home.

We passed by a small town that has a number of antique shops on our way home. The last time we were there was more than 10 years ago (see previous post). My son who was less than 3 years old at that time, accidentally knocked down an antique mirror sitting on a floor at one of the stores. The mirror fell on its face and shattered the glass into several pieces. I ended up paying $200 dollars. Since I paid for it, I took home the wood or board where the mirror was mounted. $200 for a piece of board!

They say that breaking a mirror will cause seven years of misfortune. I don’t think so. What followed was several years of bliss living in Iowa.

This time we did not shatter any mirrors. Just shattered expectations, I guess. After that last stop, we came home after almost 6 hours on the road.

Have you had any similar experience? Going to a place that did not live up to your expectations? Did we just wasted a day and some gallons of gas? I don’t want to believe so. For even if the destination was less than spectacular, we still spent some quality family time together.

Life is a journey. Sometimes it is not the destination that matters. But it is the joy of experience, discovery, shared moments together, and the eventual precious memories during the travel, that really matters.

It’s summer here in our place. Well, not quite officially, as the summer solstice is not until June 21 which marks the official start of summer in the northern hemisphere. Yet the mercury is rising, as our high temperature for the past few days and the coming week will be in the 90’s to even reaching 100 º F.

But this morning, it was a comfortable 74 º F, so I went out for a run. It is also about this time of year that I should start preparing for the half marathon, if I should decide to join again this coming fall.

As I was approaching the small pond in my running route, I have to stop and let the family of geese get off the road before I could pass. The mother goose was already hissing at me as I was approaching them. They can be very territorial you know. But that’s fine, I can share the road with them, and I have no plans on swimming in their pond.

When I came to the wooded areas, I also saw a deer. But it bounded quickly away before I could take out my phone out of my pocket to take a photo. It might be sneering at me that I am too slow.

Same thing happened when I came to an area where a couple of wild rabbits were on the side of the road foraging for food. They also scurried away at the sound of my slow feet, before I can get near them. They may also laughing at me for being slow.

I admit, I am getting slower. Maybe my age is catching up on me. I have no match for the swiftness of the deer and the hare. They seem to dash so effortlessly and yet so gracefully. While me, I push for every step of my way to get to a pace that runners would even consider “running.”

Maybe all of us can relate in one way or another, and in different endeavors, that we feel we are no match to the “competition” we are going against. Whether it be in sports, or in school, or in our work, and in life in general.

Then as I was fighting my way uphill, I saw this guy.

Yes, that is a snapping turtle. And I was “quick” enough to take a photo of him.

They are called snapping turtles not because they snap their fingers as they go, rather they have the ability to snap, as in bite an attacker. That’s why I kept my distance.

The pond, or any body of water that I know in this area, was hundreds of meters away. I don’t know how long it would take him to get there, if that was where he was heading. But I’m sure his slow pace does not stop him from continuing, for that’s who he is.

It gave me a good insight for the day. Life they say could be like a race. But it is not always for the swift, but to those who kept on running.

During my last weekend call, one of the many admissions I had to the ICU was a man in his 70’s, who was found unresponsive in his home. Since he lives alone, he probably have been lying on the floor for a couple of days before he was found.

After work-up in the emergency room, it was determined that he had a large stroke. As he was very sick and unstable, we were consulted to admit him in our ICU.

The next day, after providing supportive measures, his vital signs stabilized and he became more responsive, and even following simple commands. Yet he still has significant neurologic deficits due to the devastating stroke.

The patient’s son who was the power-of-attorney, talked to me and showed me his father’s living will, which specifically detailed that in case he had an “irreversible condition,” he does not want to be on any form of life support including artificial nutrition, like tube feedings or even intravenous fluids.

I assessed that with the severity of the stroke, the likelihood of “good” recovery was doubtful. My projection was that he would never live independently again, would most likely be nursing home-bound, and definitely would not be the same person that they know. In addition, he could even get worse as the swelling of the brain increase. No question, I painted a grim scenario.

After hearing my assessment, the patient’s son and family, were ready to call hospice and just make the patient comfort cares. The son told me that his father, for sure would not like to live a life with such a poor quality as I have projected. Though I told them, that the neurologist whom I consulted have not seen the patient yet, and perhaps they should wait on what he has to say.

Not long after, the neurologist came. He extensively reviewed the CT scan of the head, and he made a careful and detailed neurological examination of the patient, as he tried to evoke even obscure reflexes that I can only read in the medical textbook. After his evaluation, the neurologist, the patient’s son, and me, went in a room for a conference.

The neurologist explained that with his estimation, even though the stroke was large, since it involved the non-dominant side of the brain and mostly the frontal lobe, he believes that the patient can still have a “meaningful” recovery. In addition, since the acute stroke was a few days ago, he thinks that the swelling was on its way down, and perhaps we were already past the worst phase. He backed this with his expert knowledge of brain anatomy and function.

Thus the neurologist believed that at best, though it may take months of rehabilitation, the patient can talk – though with a funny accent, walk – but with a limp that he even demonstrated, and maybe could even live independently later on. He definitely painted a more rosy picture than the gray picture that I have painted.

Hearing the neurologist’s opinion, it was obvious we have a “slight” difference of opinion. Perhaps slight was an understatement.

After considering the neurologist’s evaluation, the son and the family changed their mind and decided to defer calling hospice and instead support the patient as much as possible, including tube feedings and all.

To be honest, I was a bit perturbed that I gave such a bleak prognosis than what the other doctor gave. Have I given up on that patient too soon? Have I killed the embers of hope prematurely? Perhaps I have become so pessimistic in my view of things. Perhaps I have seen so many prolonged sufferings and bad outcomes despite our best intentions and efforts in my ICU experience. Perhaps I was just saving the family from the heartaches of clinging to unrealistic optimism. Or perhaps I become more cynical and have lost my faith in hope.

In my defense, maybe I just see the front end and the acute catastrophic courses of patients in the ICU, and have limited exposure to the success stories of patients’ wonderful recovery after prolonged and extensive rehabilitation.

But even though I felt betrayed by my negativism, I felt relieved that I have heard a differing opinion, and perhaps gave a chance to a life that we almost gave up on too soon. Even though I felt embarrassed and almost apologetic for my opinion, I was thankful that we gave hope a chance. Everybody deserves that chance.

The following day, when I rounded on our stroke patient, he was more obtunded and unresponsive. He now have labored breathing and had to be placed on a ventilator. I then requested a repeat CT scan of the head.

The CT scan showed what I was afraid would happen: a further extension of the stroke and more swelling, displacing the structures of the brain beyond the midline and even herniating down the brainstem. This was unquestionably a grave condition, and most likely fatal. No more differing opinions.

The family decided to transition to comfort cares, and the patient expired a day later.

Life is a journey they say. As I commemorate my fifth decade here on earth, I decided not just to go for a trip, but for a pilgrimage. I wanted to walk where Jesus walked.

In tracing the steps of our Saviour, we ventured to Bethlehem, the birthplace of Jesus. But unlike the familiar Christmas hymn, “O Little Town of Bethlehem,” Bethlehem today is not a little town but a thriving busy city.

We were led to an old church, the Church of Nativity, where it was believed, based on tradition, to be the site of Jesus’ birth.

At the basement of this church was the marked site where He was born. But there was no shepherds. No angels singing. Just a crowd of eager people trying to make a bee line to see this site.

Then as we traveled through Israel, I saw signs that points to Nazareth, the place that Jesus spent most of His years – from His childhood until He started His ministry. But the Bible was silent about those years He spent in Nazareth.

We followed Jesus’ footsteps into the river Jordan. This is where He was baptized, signaling the start of His ministry.

Some in our group even decided to be baptized in the Jordan River.

Jordan River is not as a large and mighty as I imagined. Though it appears “muddy” as it was described in the scriptures. No wonder Captain Naaman of the Syrian army as recorded in 2 Kings, refused to dip in this water.

Yet, muddy or not, I must at least dip my hand, and my belief.

Then we followed Jesus’ footsteps into the mountains near Jericho. This is the mountain where it was believed He was tempted.

What could it be like to spent 40 days and 40 nights in this barren place? Though interestingly today, there is a stone quarry at the foot of the mountain. Definitely lots of stones that can be turned into bread.

Then we looked for Jesus’ traces in the town of Cana. This is where He performed His first miracle, where in a wedding feast, He turned water into wine.

Our trip then led us to a town that He spent some time during His ministry, a town called Capernaum or Capharnaum.

The only remains of this town today are ruins. Though the site is still beautiful as it is beside the lake, known as the Sea of Galilee. We even saw the remains of an old synagogue (photo below).

Even though we only see ruins of that Capernaum town, it showed us a glimpse, a window if you will, of where Jesus walked.

We climbed a mountain beside the Sea of Galilee. This they say is where He gave His teachings or His sermon on the mount, that became known as the Beatitudes.

As I looked at the beautiful scenery, I tried to listen through the blowing wind, to His voice and His teachings, in that Beatitude mountain.

We even had the chance to sail across the Sea of Galilee, where on this very waters, He shouted “Peace, be still,” amidst the roaring waves and howling winds. Good thing there’s no violent storm when we sailed across it.

I could even imagine the footsteps that He left on the waters, when he walked on it. But no one among us tried to walk on the water, for that will be preposterous.

We followed Him through Jerusalem. We climbed the Mount of Olives, where He spent some time teaching and praying.

From the Mount of Olives we viewed the City of Jerusalem (photo below). This is where Jesus wept when He looked into the city and the temple, knowing of its coming destruction.

Then we trace Jesus’ footsteps into the walled city of Jerusalem and walked in its streets and alleys.

We followed Him into the Garden of Gethsemane where He fervently prayed, the night before He was arrested.

Then we walked the path known as Via Dolorosa or the Way of Suffering. This is the path that he chose to walk on his way to Calvary in behalf of you and me. (Photo below is Station V of the Stations of the Cross in the Via Dolorosa)

We then went to the place known as the Skull Hill (calvarium is Latin for skull) or also known as Golgotha. This is the place believed where Jesus was crucified and died, so we can have life.

Below is the Skull Hill today. Old photos of this hill showed it is really shaped as a skull, though recent earthquakes have changed its distinct features.

Then we went to see the tomb where they laid His body after He died. (The Garden Tomb is one site, though there’s another possible site, the Holy Sepulchre Church, which we also visited.)

We even went inside the tomb. But that tomb was empty. For He is risen! And that is the very foundation of my faith.

As we celebrate this Lent season, may we contemplate on His life and what He has done for all of us.

at the Sea of Galilee

And as a pilgrim, I realize that walking where Jesus walked would be pointless, unless we also follow His will and walked spiritually as well, where He walked.

Last summer, we took a long road trip that took us from the cornfields of Iowa, to the mountainous wilderness of Montana, and to the concrete jungle of Los Angeles California. As we were pulling up into a parking lot in Los Angeles, we saw this sign that said, “Please take your valuables with you.”

I think that is a fair warning, as they don’t want you to lose something that is important. Or perhaps they just don’t want to take responsibility of any theft that will happen. Or perhaps they don’t want you to tempt others of bad thoughts by displaying something valuable, or something that they would think is valuable, inside your vehicle.

I don’t think this warning applies in Los Angeles only, as it is true in many parts of America and the rest of the world.

I remember when we were still living in New York City, somebody tried to break in into our parked car, and in the process broke the door lock of our car. And there’s really nothing of value inside, except maybe the car itself. They took my tire hub caps and antenna instead. Then we had some friends whose car windows were shattered just to get some change of coins and some barely valuable things inside their car. Maybe the thief needed coins so badly for a cup of coffee or for a ride on the subway.

Same in the Philippines. When I was still living in Manila, there’s an instance that me and my dad witnessed a car theft while we were parked near Binondo. It happened in a blitz, and they acted so smoothly that we think these guys were “professionals.” Bad use of their skills and talents, I guess. With dexterity and quickness like that, they could be show-time magicians. On second thought, they were already magicians, making things disappear!

Back to the parking lot in Los Angeles, we kind of chuckled when we read the sign. Not because it was funny nor it was an unreasonable or unusual sign. To us it was just interesting that few days before that, when we were in a national park in Montana, we read several signs that contain a completely different warning.

The warning sign when we were in the wilderness of Montana states, “Please take your trash with you.”

It was just sensible that they don’t want you to litter in such a pristine place. Plus the wild creatures, like bears, can get attracted to your trash and rummage through them. This may endanger their well-being. More so, your well-being and your life may get endangered as well, if the bear cannot find what it’s looking for (a jar of honey?) and is not happy with your trash and attacks you.

It was a totally different perspective. In one, “take your valuables with you.” In the other, “take your trash with you.”

Yes, there are places in this world that they don’t care about your valuables. It does not matter whether you’re lugging a Louis Vuitton bag or a DSLR camera with an ultra zoom lens. Just don’t leave your trash too!

This made me think, in this life, there are things that we consider our valuables. Like our fancy jewelries, our expensive toys like our cars and gizmos, our pricey wardrobes, our houses and estates, our bank accounts, and other worldly treasures. And it’s not only that there are places that they will not matter, but there will come a time as well, that all of these will be deemed worthless. Rubbish. Garbage. Trash. For you cannot take them forever with you.

I do hope that we discern what really are the important things in this life. The “valuables” that no thief nor anybody can take from you.

As I did not grow-up here and I came from a different culture, there is one question that I still don’t know how to answer truthfully even after two decades of being in the US. I am being asked this question several times a day too. I don’t think many people answer this question right as well. And it is a question that we may be asking people to lie.

You might be thinking it must be some kind of a difficult question or a complicated one. What is the question?

The question is the run-of-the-mill, perfunctory “How are you?”

Yes, we are being asked “How are you” several times a day. When we walk down the street, or down the hallway, or as we enter our workplace, or just about anywhere, people greet us with “How are you?”

I know most of the times we ask this question just to be polite. I know as well that there’s some variances in the question in some parts of the country, like “how ‘s it going” or “what’s up” or “howdy” or “hey’all.”

When I was still living in New York City, I don’t think people ask “how are you” that often, or greet that much for that matter. Or perhaps they just mind their own business. I would admit though that since I moved to the Midwest, I am being asked this question more everyday, even by people who I don’t know.

So how do you answer this question?

Do you answer also with the perfunctory “good” or “fine?” Or maybe you are really doing well so you can answer “great!” Or do you give a more honest answer, like “not good” if you’re really not feeling fine. But I don’t think people are expecting an answer different from “I’m good.” Besides we don’t want to burden other people of our own problems, right?

What would happen if a person whom you barely know, would answer you “I feel awful,” or “I feel bad.” You may think they are whiny or a grouch. But you asked them “how are you,” and they just gave you a truthful answer. Perhaps if you really don’t want to know, then don’t ask.

This is the reason, I really don’t ask this perfunctory question that much. If I want to greet someone, or be polite, or exchange pleasantries, I greet them with “good morning,” or “good afternoon,” or “good evening.” Though I may be lying with that greeting too, as it may not be really a “good” morning or evening. But at least I’m not forcing anybody to say “I’m good” when they may not be feeling good.

However due to my work, I still ask this question every day. But when I ask this question to my patients, especially in the hospital, I expect them to give me an honest answer. In fact I would be surprise if they say “I’m fine.” For if they are fine, they would not be seeing a doctor in the hospital in the first place.

So I can truthfully say that when I asked this question, I really meant to know how you are doing.

Or perhaps I am just so cynical, thinking people ask “how are you” or “how do you do” without really meaning it. Maybe they really do care to know how you feel.

In the song “What a Wonderful World” by Louis Armstrong, it says:

The colors of the rainbow so pretty in the sky,
Are also on the faces of people going by,
I see friends shaking hands saying, “How do you do?”
But they’re really saying, “I love you.”…….

Returning home one evening after dropping off my daughter to her university, I came to this rest area. Since I was still several miles away from home, and needed to take a leak, so I use the rest stop.

Rest Stop where I stopped

For the weary road traveler, rest stops are such an inviting place. Especially if they are beautiful, clean, and well maintained, like the one I used above. For people with hyperactive bladder, like me, rest stops are life-savers.

Many times we just stop to take a bathroom break. Though sometimes we take a rest for several minutes to stretch our legs or take a walk. While some take a longer break and even sleep for a few hours in their car or truck, before continuing on their long journey.

Not to brag, and since I have driven from America’s coast to coast, I believe rest stops here in Iowa are among the cleanest and well-maintained facilities. Of course I’ve also been to ones that are not worth a stop at all.

The world’s largest rest stop or truck stop is found here in Iowa along I-80. This stop has pretty much anything a road warrior needs. In addition to plenty of fast food restaurants, there is a movie theater, a laundromat, showers, a trucking museum, and a church that have service on Sundays.

Though rest stops are not meant to be our final destination. They are mere transient stops along the way. They are just there to provide us a respite from the weariness of our long travel. And that’s should be true as well in our life’s journey.

Few days ago, I learned from our batch that two of our classmates from medical school passed away. One died from a “lengthy illness” according to his obituary. While the other died suddenly from a ruptured brain aneurysm while he’s on a trip.

Of all circumstances, dying while on a break or a vacation, to me is just not right. Perhaps some will say, at least your last memories are of a happy occasion. But then again, is there really even a “good” time to die?

I am deeply saddened by these news. I guess me and my classmates and contemporaries are now in that age that we can get seriously ill and die. Though I would say, they were still too young to die.

The one who died suddenly from a ruptured aneurysm was a classmate of mine not just in medical school in the Philippines, but even since we were in pre-med. Besides being in the same classroom together since our teen years, we also played a few basketball games together, went to some outings together, and much more.

Then when we were both doing our post-graduate training here in the US, when I was applying for my subspecialty training, I even stayed in his home for a couple of days when I had an interview in Chicago, where he was still living at that time.

He worked in the US for several years, but he left a lucrative cardiology practice here, and went back to the Philippines last year, to practice back home and serve our own people. Perhaps he’s more nationalistic than I am. Or perhaps he just wanted to go home.

In one level or another, he did go home.

The last time I saw him was in Manila during our 25th graduation anniversary from University of Santo Tomas (UST) medical school, earlier this year. At one time, after a whole day event in UST, we, together with other friends went to a restaurant near Ortigas for a night-cap. Even though the place was probably less than 10 miles from the school, it took us almost 2 hours to get there due to horrible traffic. Who needs a rest stop, when we were already stopped all the time?

As I was riding with him in his car and we were stuck in Manila’s traffic, at least this gave us more time to catch up with each other’s lives. Never did I imagined, that will be the last time we’ll spend time together, and that will be our last shared trip.

Our life’s journey is so unpredictable. We plan for a long haul, but at times our travel is shortened. Way too shortened. Some of us will arrive at a rest stop. And it’s a permanent rest stop.

Actually, I set them up since last week. Only to take them down again.

No, it’s not that the neighbors complained that it was too early for Christmas. It’s not that we contemplated on canceling Christmas. And it’s not that Santa is not coming to town. Nothing like that.

Why I took the lights down has a more rational reason.

Last week, when we were experiencing a seasonably warm November (up to 70’s degrees Fahrenheit), I decided on a whim to put the Christmas lights up. I hang them up at the edge of our roof. I rather put them up when it was warm and not when it’s bone-chillingly cold.

So with my trusty ladder, and with the help of my son, I climbed up and dangled our Christmas lights for all the neighbors to see. By the way, I was not the earliest among our neighbors to set up Christmas lights. I saw one down the road, even two weeks earlier than me.

Risking life and limb (maybe not life, only limb, for it was only 10 feet high), and after more than an hour of work, I completed setting our outside Christmas lights up. I was so proud of my accomplishment.

Only to find out, after I plug them in to the electric outlet, that almost half of the lights were not working. What a bummer!

All my efforts and time spent were gone down the drain. I suddenly felt my back really ached. Maybe it was more imagined than real. I almost got a headache too, when I thought of banging my head to the wall!

I have no one to blame but me. Why did I not check the lights if they’re working or not, before I hang them up? Yeah, very brilliant of me.

I left the unplugged bum lights hanging for a week , while I let my disappointment simmer down a bit.

Then this week, after getting a new set of Christmas lights, which I think was time for an upgrade anyway, I finally took the old non-working lights down, and hang up my new brighter and yet more energy efficient LED lights.

And yes, I tested them first, even if they’re new, before I hang them.

Our temperature also got significantly colder this week, with the lowest in the 20 – 30’s degrees Fahrenheit. But I just bundled up, suck it up, and do what I needed to do.

As I look at our Christmas lights tonight, somehow they look more beautiful than ever. They better be, for I spent double the time and effort putting them up. Make you appreciate the things that you work your tail off.

Of course I also gained a notable experience and a valuable lesson learned: never assume, always check it out first. And that just not apply to Christmas lights.

Last week, we had a patient in the ICU who was unwell. Unwell, is perhaps an understatement.

He was of an advanced age though, as he was in his 80’s, and maybe has already lived a full life. Yet he was still active, lives independently with his wife, and was in relatively good health, until he got sick and got admitted to the hospital.

He came down with a bad bout of pneumonia. So bad that he went into respiratory failure and had to be placed on mechanical ventilator. This was complicated as well, as he suffered a mild heart attack too. Furthermore, he also developed brisk bleeding in his stomach, but fortunately we were able to stop that bleeding, when we did the gastroscopy.

After several days of intensive support, surprisingly he got better. He got better enough that we were able to take him off the ventilator. He was going to pull through this. So we thought.

But less than 24 hours later, he was placed back on mechanical ventilator. His blood pressure dropped as results of overwhelming infection. He went into congestive heart failure. His kidneys also started to fail. His condition got worse than ever.

We sat down with the patient’s family and discussed with them the dire situation. They decided that they would like to continue the aggressive support and hang on for two more days. I thought it was kind of odd to have so specific timeline in their request.

Why two days?

Two days later, as we’re going through our morning rounds, I was told by my staff that we will be having a party later that day. A birthday celebration right there, in the ICU.

I learned that the family of our elderly patient have called all the family members that can come, to be there and visit the patient. They brought balloons and a large birthday cake. They even brought in the patient’s dog to the ICU! But of course they have to get a permit and confirm all the vaccination records of the dog.

I also learned that the family was planning to take him off life support that same day. They would like to transition to full comfort care, and let nature take its course.

The ICU staff got a birthday card that they passed around and asked us all to sign it. Honestly, I was stumped on what to write on the card.

Do I write “Happy Birthday,” knowing that it may not be really a happy event? Or do I write “May you have more birthdays to come,” which I know would not be true at all? Or should I write “Have a good last birthday?” But that sounds morbid! Or do I write “May you have peace on your birthday,” which I think is very appropriate, but it is as if I’m foretelling death before it actually happen?

Never did I have so much difficulty in writing a simple greeting on a birthday card before.

When the family were ready, we lightened the sedation and have the patient wake up, so he will at least have the chance to witness his own birthday celebration.

The ICU staff came and crowded inside his room and sang “Happy Birthday.” Though I guess, many of us we’re feeling rather sad than happy while singing that song.

We then extubated the patient and took him off the ventilator. He was able to speak after that, though very weakly. The family gave him a piece of his birthday cake which he tasted, even if it was just the frosting.

After a while, he started to show signs of discomfort. He was obviously struggling even just to take a breath. So after the final embraces from the family and a pat to his dog, we gave him medications to relax him and made him more comfortable. He slept the rest of his birthday celebration.

He later slept on into the eternal night.

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P.S. I wrote on his birthday card, “May you have a meaningful birthday.”